A cascade of care for urinary stone disease (USD) [Meeting Abstract]
Background: USD is a preventable disease characterized by significant risk of recurrence. A "cascade of care" shows how many patients are lost to follow-up at diagnosis, referral, and treatment and is a useful tool in delivering HIV care. We can analyze our success, or failure, in the secondary prevention of kidney stones and retention of patients by constructing a cascade of care.
Method(s): We abstracted data from observational studies to identify impediments to care of patients with USD Results: In the US there are about 1.2 million ER visits per year. 37% of patients diagnosed with stones receive a follow-up consultation with a urologist and fewer see a nephrologist. Although 24h urine collection results may decrease stone recurrence rate, only 7.4% do them. 50% of patients experience a recurrent 2nd episode within 5 years. Of these 24% undergo a complete evaluation, 18% are referred to a nephrologist and 13.8% are prescribed medical therapy. 30% remain adherent to this pharmacotherapy. Of patients that are adherent 27% have lower odds of an ER visit than non-adherent patients. The cascade of care demonstrates that a low prevalence of patients receive proper followup. The impediments to the care of patients with kidney stones are (1) the unrecognized comorbidities of stones (2) disconnect between the ER and stone experts and (3) the low prevalence of 24h urine collections and prescribed medical therapy.
Conclusion(s): It is important to identify loci in the cascade of care that could represent opportunities to change practice. Prescription of appropriate fluid therapy and dietary changes and a referral to an expert should 1st be initiated by the ER. The low prevalence of 24h urine collections may reflect that the data are intimidating for some. Empiric therapy for calcium stones with fluids, diet, thiazides and potassium citrate may be a rational therapy to achieve significant supersaturation reductions and could be compared with targeted medical therapy in a randomized controlled trial. A greater effort needs to be devoted to develp a comprehensive flow of participants to retain patients in the cascade of care for USD. (Table Presented)
The role of the microbiome in kidney stone formation
Nephrolithiasis is a complex disease of worldwide prevalence that is influenced by both genetic and environmental factors. About 75% of kidney stones are predominantly composed of calcium oxalate and urinary oxalate is considered a crucial risk factor. Microorganisms may have a role in the pathogenesis and prevention of kidney stones and the involvement of the intestinal microbiome in this renal disease has been a recent area of interest. Oxalobacter formigenes is a gram negative bacteria that degrades oxalate in the gut decreasing urinary oxalate excretion. In this review, we examine the data studying the role of Oxalobacter formigenes kidney stone disease in humans and animals, the effect of antibiotics on its colonization, and the potential role of probiotics and whole microbial communities as therapeutic interventions.
Rewiring Redox-Sensitive GFP for Dynamic Imaging of Mycothiol Redox Potential in Mycobacterium Tuberculosis during Infection [Meeting Abstract]
Perceptions regarding barriers and facilitators to combination antiretroviral therapy adherence among people living with HIV/AIDS in Gujarat, India: A qualitative study
OBJECTIVES/OBJECTIVE:To know the perceptions regarding barriers and facilitators to cART adherence among people living with HIV/AIDS MATERIALS AND METHODS: To adapt U.S. based SAFETALK "prevention with positives" intervention to be culturally relevant in Gujarat, India in assisting PLWHA, a formative study was conducted. We conducted 30 in-depth interviews with PLWHA in the local language, assessing the experiences, perceived barriers, and facilitators to combination antiretroviral therapy (cART) among PLWHA in Gujarat. PLWHA were selected from the Voluntary Counseling and Testing Centre (VCTC) in Gujarat. To triangulate interview findings, we conducted two focus group discussions (FGDs) with medical and non-medical providers, respectively. RESULTS:Travel and commuting to clinic, fear of possible physical reactions, high cost of ART from private practitioners, CD4 count being in normal limits and resistance to medication acted as barriers to cART adherence. Initiation of cART was facilitated by family members' suggestion, advice of treating doctors and counselors, appropriate counseling before starting cART, belief that cART would aid in living a better and longer life and due to lowering of the CD4 count. INTERPRETATION AND CONCLUSIONS/CONCLUSIONS:Our study suggests that several issues need to be considered when providing cART. Further research is needed to study interactions between patients and their health care providers.
Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a 1-year, phase IIa, single-arm, open-label clinical trial
OBJECTIVE:To assess the safety and effectiveness of imatinib mesylate in the treatment of diffuse cutaneous systemic sclerosis (dcSSc). METHODS:In this phase IIa, open-label, single-arm clinical trial, 30 patients with dcSSc were treated with imatinib 400 mg daily. Patients were monitored monthly for safety assessments. Modified Rodnan skin scores (MRSS) were assessed every 3 months. Pulmonary function testing, chest radiography, echocardiography and skin biopsies were performed at baseline and after 12 months of treatment. RESULTS:Twenty-four patients completed 12 months of therapy. 171 adverse events (AE) with possible relation to imatinib were identified; 97.6% were grade 1 or 2. Twenty-four serious AE were identified, two of which were attributed to study medication. MRSS decreased by 6.6 points or 22.4% at 12 months (p=0.001). This change was evident starting at the 6-month time point (Î”=-4.5; p<0.001) and was seen in patients with both early and late-stage disease. Forced vital capacity (FVC) improved by 6.4% predicted (p=0.008), and the diffusion capacity remained stable. The improvement in FVC was significantly greater in patients without interstitial lung disease. Health-related quality of life measures improved or remained stable. Blinded dermatopathological analysis confirmed a significant decrease in skin thickness and improvement in skin morphology. CONCLUSIONS:Treatment with imatinib was tolerated by most patients in this cohort. Although AE were common, most were mild to moderate. In this open-label experience, improvements in skin thickening and FVC were observed. Further investigation of tyrosine kinase inhibition for dcSSc in a double-blind randomised placebo controlled trial is warranted. ClinicalTrials.gov, NCT00555581.
Activation of the type IIFN pathway in systemic sclerosis (SSc) is detected at the level of PBMC gene expression: Association with higher skin scores, inflammatory markers and anti-ro antibodies [Meeting Abstract]
Phase IIa trial of imatinib mesylate (Gleevec) in the treatment of diffuse systemic sclerosis - An interim analysis [Meeting Abstract]